> 
I tell mothers that hearing so much mixed advice will drive them crazy -- but it means that breastfeeding tends to work, even though mothers do many different things.  Each mother/baby team will work out their own rhythm, and a big factor is how much storage capacity the mother has.  Some mothers have a great milk factory, but limited warehouse space, and they need to keep the product moving, from both sides, to keep the production in balance.  Other people make enough and store enough that the baby will be happy with what's available in one breast, at least at some feeds.

I tell mothers that in the early weeks they can help the baby do a good job on the first side, and a sleepy newborn might need some encouragement, maybe give them a couple tries on the first side.  And when the baby slows down (after effective swallowing and softening of the breast) and comes off, bring them back up to center, and let the meal settle -- sometimes the baby will be done, and that's ok.  Or some babies need a break (when we eat we sometimes put the fork down…) before taking the second side.  But if the baby shows any interest, it's *always* polite to offer the second side, especially in the early weeks.  Then the mother sees whether the baby is generally happy with one side, or tends to need the second.

Overthinking the foremilk/hindmilk concept can really lead people astray -- it's *all* fabulous, nutritious milk, and mothers and babies have figured this out for millions of years, by following the baby's cues.  We run up on the rocks with arbitrary advice, like "switch the baby over at 10 minutes," which will be fine for some people, but cause trouble if someone has lots of storage capacity and baby never gets to any milk beyond the first burst.  Also -- the big difference between the beginning and end (from skim milk to cream) might also be an artifact of widely spaced feedings, and very full breasts.  In cultures where babies are feeding frequently, the milk may be more in the middle range at many of the feeds.  

If a baby is having difficulties with weight gain, it's generally an overall volume issue -- not the "kind" of milk it is.  It's driving me nuts to meet with mothers with babies not gaining weight, who, on Internet advice,  are "block feeding" so that the baby will get get the "good milk."  They don't realize that that strategy, letting inventory stay on the shelves in each factory in turn, is what someone might use to slow down an oversupply.  Just offering that second side (which a mother would have naturally done if she hadn't gotten helpful "advice,")  can be a big turnaround for the team.

I know it's out of fashion, but with a slow-gaining, sleepy baby, some aggressive "switch-nursing" and hitting each side a couple of times can be a big help.

Margaret Wills, IBCLC, Maryland


> Date:    Fri, 10 Oct 2014 17:39:07 -0700
> From:    Tricia Shamblin <[log in to unmask]>
> Subject: offer both breasts at a feeding
> 
> I'm wondering what everyone thinks about this advice - offer both breasts at each feeding? I think this may be outdated information knowing what we know about hindmilk now. 
> 
> But I frequently encounter women given this advice. Am I wrong? I just tell them to put the baby on their breast and let it nurse as long as it wants to. When he comes off on his own, burp him and if he's done it's fine. If the baby seems to want more, put him on the other side. Opinions?
> 
> Thank you,
> 
> Tricia Shamblin, RN, BSN, IBCLC
> 
>             ***********************************************

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